CMS Final Payment Rule Supports Quality Hospital Care in Underserved Communities

In a significant move toward enhancing health care equity and quality outcomes, the Centers for Medicare & Medicaid Services (CMS) released a new final payment rule aiming to support inpatient and long-term care hospitals in underserved communities. According to press release, the rule supports the Biden-Harris Administration's commitment to historically underserved and under-resourced communities and is poised to foster safety, equity, and reduced preventable harm within the hospital setting.

The fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule brings about several noteworthy changes, according to the statement. The comprehensive update encompasses Medicare payments, policies, and hospital quality measures, aligning them with the administration's priorities.

The rule, applicable to both inpatient and long-term care hospitals, aims to improve care quality and safety for all individuals while addressing disparities that have long plagued the health care system.

Promoting Health Equity and Quality Outcomes

A hallmark of this rule is an emphasis on advancing health equity, particularly for historically marginalized communities. CMS incorporated various measures to address this goal.

One of the measures is a health equity adjustment in the scoring methodology for the Hospital Value-Based Purchasing (VBP) Program. Hospitals catering to a higher proportion of dual-eligible patients will be rewarded for providing excellent care.

“As part of CMS’ health equity goals, we are rewarding hospitals that deliver high-quality care to underserved populations and, for the first time, also recognizing the higher costs that hospitals incur when treating people experiencing homelessness,” Chiquita Brooks-LaSure, CMS administrator said in the statement. “With these changes, CMS is laying the foundation for a health system that delivers higher quality, more equitable, and safer care for everyone.”

While this marks an important first step toward promoting health equity within the Hospital VBP Program, the CMS has sought public input on additional strategies to further incorporate equity adjustments in the program for the years ahead. Reportedly, this may entail restructuring scoring methodologies and identifying the most effective metrics for identifying underserved populations.

Acknowledging Homelessness and Rural Care

In an acknowledgment of the unique challenges faced by individuals experiencing homelessness, the CMS has finalized a policy recognizing the elevated costs that hospitals incur when treating these patients. Hospitals that report social determinants of health codes on claims will now generally receive higher payments when attending to patients who are homeless.

This rule extends support to rural and other underserved communities by permitting rural emergency hospitals (REHs) to be designated as graduate medical education training sites. This decision aligns with the Biden-Harris Administration's dedication to enhancing health care workforce opportunities in regions that have often been underserved.

The CMS rule also formalizes requirements for the additional information that eligible facilities must submit when applying for enrollment as an REH, in accordance with the law. This move aims to increase access to vital health care services in rural communities and streamline the enrollment process for facilities seeking the REH designation.

According to the CMS, by acknowledging the unique challenges faced by historically underserved and under-resourced communities, this rule exemplifies the commitment to creating a fairer and more accessible health care landscape for all individuals.

Reference

New CMS rule promotes high-quality care and rewards hospitals that deliver high-quality care to underserved populations. News release. Centers for Medicare & Medicaid Services (CMS). August 1, 2023. Accessed August 15, 2023. https://www.cms.gov/newsroom/press-releases/new-cms-rule-promotes-high-quality-care-and-rewards-hospitals-deliver-high-quality-care-underserved